title: Aortic valve regurgitation that resolved after a ruptured coronary sinus aneurysm was patched.
abstract: Sinus of Valsalva aneurysms appear to be rare. They occur most frequently in the right sinus of Valsalva (52%) and the noncoronary sinus (33%). More of these aneurysms originate from the right coronary cusp than from the noncoronary cusp. Surgical intervention is usually recommended when symptoms become evident. We report the case of a 34-year-old woman who presented with a congenital, ruptured sinus of Valsalva aneurysm that originated from the noncoronary cusp. Moderate aortic regurgitation was associated with this lesion. Simple, direct patch closure of the ruptured aneurysm resolved the patient's left-to-right shunt and was associated with decreased aortic regurgitation to a degree that valve replacement was not necessary. Only trace residual aortic regurgitation was evident after 3 months, and the patient remained free of symptoms after 6 months. Our observations support the idea that substantial runoff blood flow in the immediate supra-annular region can be responsible for aortic regurgitation in the absence of a notable structural defect in the aortic valve, and that restoring physiologic flow in this region and equalizing aortic-cusp closure pressure can largely or completely resolve aortic insufficiency. Accordingly, valve replacement may not be necessary in all cases of ruptured sinus of Valsalva aneurysms with associated aortic valve regurgitation.
authors.affiliation: Departments of Cardiology (Drs. Joggerst, Nascimbene, Reddy, Stainback, and Wilson) and Cardiovascular Surgery (Drs. Cervera and Ott), Texas Heart Institute, Houston, Texas 77030.
authors.forename: Angelo
authors.initials: A
authors.lastname: Nascimbene
authors.forename: Steven
authors.initials: S
authors.lastname: Joggerst
authors.forename: Kota J
authors.initials: KJ
authors.lastname: Reddy
authors.forename: Roberto D
authors.initials: RD
authors.lastname: Cervera
authors.forename: David A
authors.initials: DA
authors.lastname: Ott
authors.forename: James M
authors.initials: JM
authors.lastname: Wilson
authors.forename: Raymond F
authors.initials: RF
authors.lastname: Stainback
mesh_terms: D000328:Adult; D001019:Aortic Rupture / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D006348:Cardiac Surgical Procedures; D018618:Echocardiography, Doppler, Color; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D006439:Hemodynamics; D006801:Humans; D010496:Pericardium / Q000637:transplantation*; D012850:Sinus of Valsalva / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Aortic aneurysm/congenital/etiology/radiography/surgery; aortic valve insufficiency; cardiac surgical procedures/methods; differential diagnosis; sinus of Valsalva/pathology/radiography/surgery; treatment outcome